The temporomandibular joint (TMJ) is the link between the mandible bone and the skull. The mandible is commonly known as the lower jaw. The TMJ is found anterior to the ears on the side of the face. The joint connects to the skull’s temporal bone and the mandibular bone, acting as a hinge.
The TMJ is responsible for the opening and closing of the mouth. Opening and closing of the mouth allow a person to speak, bite, yawn or eat. The abbreviated form TMJ is also used to refer to conditions that affect the joint itself. However, for specificity, the initials TMJD and TMD can be used to refer to these conditions.
According to various studies, millions of people suffer from TMJ disorders, with the incidence being higher in women than men. In most cases, if you seek early diagnosis, treatment and recovery is possible.
We do not know the exact etiology of TMJ disorders. The latter is due to the multifactorial nature of the reasons. Most dentists believe that the causes have to do with the TMJ itself or the muscles around the mandible.
A common cause of TMJ disorders is injuries that affect the head or neck muscles or cause damage to the jaw or the joint. For example, a heavy blow or a whiplash can harm the joint severely. Trauma in this region can lead to jaw misalignment. Other causes include:
- Constant clenching or grinding of the joint, also called bruxism
- Movement, displacement, or erosion of the soft disc cushion in between the two bones
- Conditions that are present from birth due to impaired fetal development
Other secondary causes have been identified. These causes include:
- Orthodontic braces
- Poor diet
- Poor sleeping patterns
- Chewing of gum
- Prolonged stress
Common symptoms of TMJ disorders are:
- Jaw pain
- Popping sound in the ears
- Jaw stiffness
- Tenderness or pain around the jaw, temple, neck, and shoulders
- Popping or clicking sounds when opening the jaw
- Swelling around the joint
- An uncomfortable sensation when chewing
- Pain in the ear
- Ringing sound in the ears – tinnitus
Making a Diagnosis
To determine the exact nature of your disorder, a dentist will have to take your history and perform a physical examination around the head and neck. The dentist will look for pain and tenderness and listen for clicking, popping, or grating sounds when moving the joint. Another possible issue we could look for is the intensity of your bite and associated facial muscle movements.
Sometimes, it is necessary to carry out x-rays testing to better view the bone anatomy around your TMJ. Further tests may include magnetic resonance imaging (MRI) and Computerized Tomography (CT) scans to observe the TMJ disk and the details of the bones, respectively. All the scans are painless and will not cause any side effects in most people.
Fortunately, there are various treatment options for TMJ disorders. Depending on the severity of the case, our dentists can either recommend home-based treatment or various medical interventions.
Some of the most prevalent home-based treatment include:
Over the Counter Medication
In uncomplicated cases of pain or inflammation, the doctor may recommend pain and inflammation relieving medications. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as paracetamol, naproxen, aspirin, and ibuprofen are often sufficient to alleviate pain and swelling.
The objective behind this treatment option is to avoid foods that strain the joint by either biting too hard or opening the mouth too wide. Therefore, hard, chewy, and crunchy foods such as raw carrots and caramel should not be part of your diet.
Instead, go for soft food or food that can be cut into small pieces. Yogurt, mashed potatoes, scrambled eggs, beans, and cooked vegetables are examples of great alternatives.
Cold and Hot Packs
You should take a cold pack in this method and hold it against the temple just above the joint. If the dentist or physiotherapist recommends it, you can try stretching the jaw while holding the pack.
After removing the pack, hold a warm cloth or towel against the region for about five minutes. Repeating this routine several times a day is advised.
Avoid Straining the Jaw
Movements that strain the jaw should be avoided or minimized. You can do this by:
- Minimizing movements or actions that open the jaw wide such as yawning, singing, yelling, and chewing gum.
- Avoiding postures that reduce strain on the neck or face, such as resting your chin on your hand
- Minimize clenching, such as by keeping your teeth slightly apart
- Using relaxation methods that help in loosening the jaw, such as therapy or massages
For more severe cases, doctors may recommend:
More Potent Pain-Relieving Drugs
Sometimes, over-the-counter therapy such as NSAIDs may be insufficient to counter the pain and inflammation. In such instances, the dentist may prescribe higher doses or muscle relaxants. Examples of muscle relaxants include metaxalone and cyclobenzaprine.
An alternative treatment course is antidepressants and anxiolytic drugs if stress has a role in the TMJ disorder. This treatment alternative is prescription only and includes drugs such as diazepam, clonazepam, and imipramine.
Dental Splints and Night Guards
These are pieces of plastic made to fit into the mouth in a way that keeps the lower and upper teeth from touching. These mouthpieces ease the clenching and grinding that strains the jaw.
A splint differs from a night guard in that it can be worn at all times, while the latter is only used when sleeping. Depending on the symptoms, your dentist will recommend the most appropriate option.
Alternatively, the dentist may suggest replacement of the joint if all other available options are not feasible. This procedure is also called arthroplasty or total joint replacement surgery. Both the socket and the ball are replaced with an artificial joint made from titanium and dense plastic.
This replacement joint is less susceptible to wear and tear compared to the natural joint. Arthroscopy is similar to arthroplasty and is one of the most preferred surgical interventions because it:
- Has very few potential complications
- Is minimally invasive
- Requires a short time for full recovery
- Leaves little scarring
Alternatively, the dentist may choose to do arthrocentesis. This procedure is mainly used where the jaws are locked with no history of TMJ disease. The dentist first anesthetizes you before inserting needles to wash the joint out. Arthrocentesis can:
- Remove damaged tissue in the joint
- Pry the joint to make it more mobile
- Free the disk if it is wedged in the joint
This option is only viable if the other two options above are not medically possible. Instances that may necessitate this surgery are:
- Presence of tumors around or in the joint
- Scarring or bone fragments in the joint
- Worn bones around the joint
The doctor will anesthetize you then operate on the joint after opening up the region around the joint. This intervention is not frequently recommended because recovery takes longer, and it may damage some nerves.
If the complications are caused by stress, behavioral therapy may be applied to reduce stress. Alternatively, anesthetic agents and pain relievers can be injected into the joint on tender muscles around the face, referred to as trigger points.
Radio wave therapy has been shown to stimulate blood flow to the joint, offering pain relief. Low electrical currents can be used to relax the muscles around the joint, which helps relieve pain.
Heat applied through ultrasound can help make the jaw more mobile or relieve soreness. Botox injections also help reduce tension and soreness. Even though some reports that this treatment helps, it is yet to get FDA approval.
TMJ disorders are often manageable, with treatment options depending on the causality and diagnosis.
In most cases, home remedies and lifestyle changes are enough to manage TMJ disorders. However, in cases where chronic conditions such as arthritis are the cause, this may not be adequate. The focus of treatment in such cases is easing discomfort alongside other lifestyle modifications, most of which our doctors can help you figure out.
If you speculate that you may have a TMJ disorder, you can visit our premises, where our doctors will give you an accurate diagnosis and prognosis. Our able team can advise you on the best medication or course of action.